1岁以下婴儿室间隔缺损的早期外科治疗

PRIMARY SURGICAL CLOSURE OF VENTRICULAR SEPTAL DEFECTS IN THE FIRST YEAR OF LIFE

目的探讨１岁以下婴儿室间隔缺损一期根治术指征及围术期处理。方法对３８例１２月龄以下婴儿室间隔缺损行一期根治术。平均年龄（８．１±３．４）月，平均体重（６．８±１．８）ｋｇ。超声心动图证实室间隔缺损，膜部流入道型２４型，双动脉干下型１４例，缺损直径７～１５ｍｍ，并提示２１例伴有不同程度肺动脉压力升高。９例行右心导管检查，肺动脉收缩压为（７．７±２．０）ｋＰａ，肺循环阻力为（５８．７±１２．１）ｋＰａ·ｓ／Ｌ。采用中度低温（ｎ＝２７）或深低温低流量（ｎ＝１１）体外循环技术行一期根治术。年龄６个月以下者为组Ⅰ（ｎ＝１４），大于６月龄者为组Ⅱ（（ｎ＝２４）。结果全组手术无死亡。主要并发症为气胸和肺不张，两组相比无显著差异。术后早期肺动脉压力即降至正常，心功能明显改善。结论１岁以下婴儿室间隔缺损一期根治术手术安全，疗效满意。

URPOSE To evaluate the early result and to discuss the indication and perioperative management of primary surgical closure of ventricular septal defects (VSD) in small infants.METHODS Thirty eight small infants met the criteria for inclusion in the study. The age and body weight were (8.1±3.4) months and (6.8±1.8)kg respectively. The locations of VSD were at the inlet septum in 24 patients and at the subarterial septum in 14 patients. The pulmonary systolic pressure in 9 cases underwent cardiac catheterization before operation was (7.7±2.0)kPa and the pulmonary resistance was (58.7±12.1)kPa·s/L. Patients were divided into two groups based on the age: group Ⅰ infants aged 6 months or less (n=14) and group Ⅱ aged more than 6 months (n=24). Primary surgical closure was performed under moderate hypothermia (n=27) or deep hypothermia with low perfusion volume (n=11) cardiopulmonary bypass.RESULTS No early or late deaths occurred in both groups. Major complications occurred similarly in both groups (21.4% in group Ⅰ versus 16.7% in group Ⅱ, P>0.05). No patients have required a second operation. The pulmonary pressure decreased significantly early after the closure of VSD.CONCLUSIONS Findings imply that early surgical closure of VSD is indicated in patients with nonrestrictive VSD associated with congestive heart failure or growth retardation.